Estrogen Therapy Woes

Published: March 3, 2004

Another stake has been driven into hopes that long-term hormonal treatment might provide health benefits to postmenopausal women. The National Institutes of Health halted a trial of estrogen therapy in thousands of American women this week because it increased the risk of stroke and failed to protect against heart disease, the main potential health benefit. The findings give further reason to limit hormone therapy primarily to uses where all agree it is valuable: short-term treatment to relieve acute symptoms of menopause, like hot flashes and vaginal discomfort.

The latest findings contribute to the woes that have dogged hormone therapy for the past two years. Although the treatment was once promoted as an anti-aging elixir to ward off chronic illness and make women feel more energetic, mentally sharper and more sexually responsive, a series of studies have questioned its presumed benefits and highlighted the risks. In July 2002, federal health officials halted a large-scale trial of a combined estrogen-progestin pill that was causing more harm than good, notably by increasing the risk of breast cancer, heart disease and strokes. Now a part of the study that used estrogen alone for women who had had hysterectomies has also been halted. This was a closer call -- the dangers were fewer and expert advisers were split. But the estrogen pills clearly increased the risk of stroke and may also have increased the risk of dementia or mild cognitive impairment, undercutting the belief that the pills are good for mental alertness. The most encouraging finding was that estrogen alone, unlike the combination pills, did not increase the risk of breast cancer. That should relieve the concerns of many women who have taken estrogen for years.

The hormone treatments clearly reduce the risk of hip fractures. But health officials recommend that hormone therapy for hips be considered only for women at significant risk of osteoporosis who can't take alternative medications. The best advice is to use the lowest dose for the shortest time possible.